1. 1Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, NY, NY, 2Department of Biomedical Informatics, NY, NY, and 3Department of Information Services, NewYork-Presbyterian Hospital, NY, NY
Barbara Ross, RN BSN CIC1, Frank Hong, MA2, David K. Vawdrey2, PhD, Rohit Chaudhry, MS3
Automated Identification and Communication of Patient Isolation Information via the
Electronic Medical Record at a Large Academic Center
Background:
Before 2010, Infection Preventionists (IP) manually screened paper
micro reports for patients with multi-drug resistant organisms
(MDRO) and other communicable conditions (CC)
Once potential cases were identified, IPs at NewYork-Presbyterian
Hospital accessed 6 clinical systems (admitting, lab, EMR) to
determine if further action was necessary
In 2008, Infection Prevention & Control (IP&C) collaborated with IT
and Columbia University Department of Biomedical Informatics to
develop an automated electronic surveillance system (EpiPortal)
designed to:
• Improve ID of patients with MDROs and other CCs
• Ensure timely isolation to prevent exposure of other patients,
visitors, and staff
Problem:
Healthcare-acquired infections (HAI) with MDROs and CCs increase
patients’ morbidity, mortality, length of stay, and healthcare costs
New report published by the CDC in 2013:
• MDROs infect >2 million people, 23K deaths
• Clostridium difficile infect 250K with 14K deaths
Project Goals:
1. Create an electronic surveillance system to decrease time spent
by IPs to review micro culture results allowing them to focus on
HAI prevention efforts
2. Provide 24 X 7 access to patients' isolation information to
clinicians when IP&C staff are not in the office
Methods:
Phase 1: EpiPortal Isolation Module
• Provides access to information systems (census, location trail,
micro laboratory results, susceptibility profiles, etc.) within a
single, summarized screen
• Aggregates data at the patient level with built-in rules/logic
based on CDC Isolation Guidelines
• Primarily driven by past or current positive micro results,
isolation orders, and/or clinical indications and symptoms
• Identifies patients with known history of MDROs/CCs upon
readmission. Includes a method to discontinue isolation when
specified criteria are met
• Conducted a pre/post implementation time study to determine
time spent by IPs to identify and isolate patients
• During this phase, fourteen IPs covered 184 in-patient units with
2,242 beds (~738,000 in-patient days). Of the total 12,182
positive cultures reviewed, 12.8% were MDROs
Results:
Phase 1:
Phase 2: 2010, EpiPortal isolation module incorporated into a tab in
Eclipsys XA™ system (Micro-Epi tab)
• When a patient's isolation status is updated in EpiPortal, it is
immediately reflected in the patient’s Eclipsys XA™ record
• Allows new isolation information to be processed during
nights/weekends so clinical teams receive information when the
IPs are not on site
• The Micro-Epi Tab contain patients’ past/current isolation status,
organisms, room placement requirements, and required personal
protective equipment
• Impact of the Micro-Epi tab was determined by evaluating
number of hits to the site and number of distinct users per year
Phase 1:
Phase 2:
Contact: Barbara Ross, BSN, CIC
Phone: 212.746.1754
email: bsimmons@nyp.org
Volume*
(3 months)
Volume**
(12 months)
Volume
# Patients with positive cultures 5,789 22,841
# Patients placed on isolation 2,276 9,104
# Patients removed off of isolation 148 592
# Positive Cultures 12,182 58,526
# Weekdays 65 252
Table 1: Volume of Patients and Cultures evaluated for the Time-Study
Review Time
(per action)
Total Time Based on
Volume in Table 1
(12 mon)
Total Time
Saved over
12 mon
(hours)
Old
Process
(min)
New
Process
(min)
Old
Process
(min)
New
Process
(min)
Paper micro reports
(per day)
60 1 15,120 252 247.8
Determine isolation
initiation
(per patient)
5 1 45,520 9,104 606.9
Determine isolation
discontinuation
(per patient)
10 5 5,920 2,960 49.3
Report generation
(per month)
180 30 2,160 360 30
Other features
(per case)
7.5 2 6,580 1,493 339.1
Total: 1,273.1
Table 2: Results of Time Study and Estimated Impact
Year Hits Distinct Users
2010* 1,2695 1,840
2011 20,8944 8,758
2012 38,1491 11,808
2013 YTD** 42,4571 11,080
* Actual, ** Extrapolated for 12 months
Phase 2: When just looking at the percent increase in usage for
the two full years available for comparison (2011 to 2012), there
was an 83% increase in hits/year and a 35% increase in distinct
users/year
* October - December 2010, ** January – September 2013
Table 3: Eclipsys XA™ Micro-Epi Tab Hits and Distinct Users
Conclusion:
In light of increasing antimicrobial resistance, changing economic
constraints and new regulatory requirements, implementation of
new technological solutions may allow hospitals to maintain
existing IP&C staffing levels & budget. Hospitals should consider
utilizing automated IP&C surveillance systems to aid in timely and
appropriate institution of isolation precautions. Providing isolation
information within the EMR improves communication and does
not interrupt typical workflow. These systems can decrease
variation and interpretation of the application of hospital isolation
policies and can help clinicians prevent the spread of
communicable conditions to other patients.CDC. (2013). Antibiotic Resistance Threats in the United States, 2013. Retrieved November 6, 2013, from CDC Antibiotic / Antimicrobial Resistance:
http://www.cdc.gov/drugresistance/threat-report-2013/